Mentee Qualifications

As a Mentor Program applicant, you must meet these minimum requirements:

Be a current SCMA Member

Have completed 50 hours of mediation training with providers recognized by SCMA

Have completed 50 hours of pro bono service to the courts or other DRPA agencies*

Submit a payment via credit card in the amount of $25 (non-refundable application fee) with this application.

The program fee is $345 including the $25 application fee. If accepted into the program, you will be required to pay an additional $320.

*Applicants may apply who are in the process of completing their 50 hours of service by returning a letter with this application, signed by the DRPA agency supervisor that attests to your intention to fulfill your 50 hour requirement.

Mentee Application

I have read the information on the previous page, and wish to apply for the:

Spring Term

Fall Term

Year:

I promise to respect the time of the SCMA volunteer Mentors and will devote my best efforts to fulfill the requirements of the program*

I promise

Mediation Training

Name of Training Organization 1

Number of Hours of Training

Certificate conferred?

Yes

No

Dates of Training

Name of Training Organization 2

Number of Hours of Training

Certificate conferred?

Yes

No

Dates of Training

Name of Training Organization 3

Number of Hours of Training

Certificate conferred?

Yes

No

Dates of Training

Name of Training Organization 4

Number of Hours of Training

Certificate conferred?

Yes

No

Dates of Training

Dispute Resolution Experience

Mediation Experience:

Pro Bono Service

Please provide the name(s) of the location(s) where your 50 hours of pro bono service to the courts or other DRPA Agency have been completed and specify the number of hours at each location. If your 50 hours of pro bono service are still in progress, please specify the number of hours completed, and the name(s) of the courts and/or other DRPA Agencies where you are currently performing your volunteer service.

Number of Cases Handled

Total Hours of Experience

Number of Months/Years

Non-Mediation Experience:

Number of Cases Handled

Total Hours of Experience

Number of Months/Years

Prior Education

College/University 1

Dates

Degree Conferred?

Yes

No

College/University 2

Dates

Degree Conferred?

Yes

No

College/University 3

Dates

Degree Conferred?

Yes

No

Professional Licenses

Type of License 1

Date Obtained

License/Membership #

Type of License 2

Date Obtained

License/Membership #

Has your professional license ever been suspended or revoked or have you been the subject of disciplinary action by the licensing authority?

Yes

No

If yes, please explain fully:

Work Experience

Company 1

Position

Dates

Company 2

Position

Dates

Company 3

Position

Dates

I attest that I have made full disclosure of everything requested on this application:*

(typing your full name will serve as your digital signature)

Mentee Application Fee (non-refundable)*

Price:$25.00

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card NumberExpiration DateSecurity CodeCardholder Name

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Support, Advocacy and Professional Development
SCMA is the biggest professional mediator association in Southern California for those who provide mediation services or work in the area of conflict resolution.